Poop Red Flags You Need to Know About

Everyone hopes for predictable poops. But if you happen to find a surprise in the toilet, how do you know whether to worry or flush and forget it?

St. Joe’s gastroenterologist Anthony DeBenedet, MD, discusses six types of bowel movements that you should know about, and when to call your doctor or head to the emergency room.

Bright Red Poop
“First and foremost, a large amount of blood in the toilet should be taken seriously,” says Dr. DeBenedet. “It will likely require a trip to the emergency room, especially if you’re feeling other symptoms like chest pain or shortness of breath.” Bright red blood in your poop usually means that there is bleeding in your large intestine (colon). You may require a procedure or surgery to stop the bleeding if it doesn’t spontaneously stop on its own.

But don’t rush to call the ambulance if you’ve recently eaten beets, which are notorious for turning stools red. There’s also no need to panic if you only notice a small amount of blood on your toilet paper after wiping. This is most likely from hemorrhoids or a small anal fissure (crack). However, you should still let your doctor know.

Black, Tarry Stools
“This type of bowel movement almost always requires emergency attention,” says DeBenedet. “Black, tarry stools can signal bleeding higher up in the gastrointestinal tract, which can be very serious.” For example, it could be from a bleeding ulcer in your stomach or inflammation in your esophagus.

Clay-Colored Poop
“Clay-colored stools can sometimes be a sign of liver problems,” says DeBenedet. Normally, your liver releases bile into the small intestine to help digest food. “Bile gives your stool the brown color that we’re all familiar with,” he explains.

But if your liver isn’t releasing bile into the small intestine (because it’s either not processing it correctly or the ducts that drain the bile into the small intestine are blocked), your stool can turn pale or clay-colored. If this happens, your skin and the whites of your eyes might also turn yellow (called jaundice) from bile building up in your system. Your urine may also look like Coca-Cola.

If you notice clay-colored stools or jaundice, contact your doctor immediately. Your healthcare provider can help determine what the next steps should be (i.e. come in for an office visit, draw bloodwork and/or go to the emergency room).

Thin, Ribbon-Like Stools
“While this can be a sign of colon cancer, the vast majority of people who have ribbon-like stools don’t have cancer,” says DeBenedet. Rather, they may have a condition called irritable bowel syndrome (IBS), which is very common and can also cause thin stools.

“Take note of your bowel habits over the span of about two to three weeks,” he says. DeBenedet recommends that if this type of bowel movement is a change for you and the thin stools seem to be continuing, then you should call your doctor to discuss it further.

Severe Constipation
People may have bowel movements as seldom as every three to four days, or as often as three times a day.

“This is a big range, and everyone’s a little different,” says DeBenedet. “Also, how often you have a bowel movement can change throughout your life. The important thing to remember is that you should tell your doctor if you notice a major change in your bowel habits.”

In general, if you haven’t had a bowel movement in over five days, and you’re experiencing cramping, abdominal pain or bloating, you should tell your doctor. Also tell your doctor if you need to strain for more than several minutes in order to poop.

“There’s some research showing that straining really hard can increase your blood pressure,” says DeBenedet. “Some people can even faint from it, called vasovagal syncope.” Your doctor can help ease your constipation by prescribing a stool softener or a laxative that’s appropriate for you. (Drinking warm prune juice or eating a kiwi can also work wonders.)

Extreme Diarrhea with Dehydration
“On the other end of the spectrum, if you’re having massive diarrhea—to the point where you’ve become dehydrated—that can require emergency care, too,” says DeBenedet.

Seek emergency care for diarrhea lasting more than two days with symptoms of dehydration, such as:

Severe weakness

Dizziness or fainting

Little or no urination

Dark urine

A fever over 102 degrees F

Dehydration can be life-threatening, especially for children, older adults and people with a weak immune system. If you’re a caregiver, encourage the person you’re caring for to sip on fluids—preferably fluids with electrolytes, such as chicken broth—between bowel movements and watch them closely for signs of dehydration.